Safety Nets Improve Care Coordination with HIE April 15, 2015 Carla Gibson, Senior Program Officer - REACH Healthcare Foundation Rebecca Goldberg, Principal Consultant BluePrint Healthcare IT DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
Conflict of Interest Carla Gibson Has no real or apparent conflicts of interest to report. Rebecca Goldberg Has no real or apparent conflicts of interest to report. HIMSS 2015
Learning Objectives 1 Organize regional collaborations using a program framework that unifies participants on shared goals, measurements and accountability 2 Design regional initiatives with simple, but impactful use cases for improving outcomes using current healthcare technologies 3 Create a strong communication program with executive level sponsorship 4 Create outcome measures and metrics that align with the design, and intended objectives, of the program
HIMSS STEPS Model TREATMENT/CLINICAL: Maximizing value for patients served by Safety Net organizations from the implementation of HIE to improve health outcomes. Optimizing transitions of care by enabling comprehensive and coordinated referral process, accurate and efficient patient handoffs, and tightly-coordinated transitions of care among collaborating partners. Measure and report better access to care via fewer missed appointments, closer coordination, and more coordinated hand offs as well as improved administrative efficiencies. ELECTRONIC INFORMATION/DATA: HIE utilization by Safety Net end users increased by 16% in second month. The number of secure, direct messages sent between end users increased by 500% in the first two periods measured. http://www.himss.org/valuesuite
Presenters Carla Gibson Senior Program Officer REACH Healthcare Foundation Rebecca Goldberg Principal Consultant BluePrint Healthcare IT Ms. Gibson is responsible for program and initiative development and grants administration. Carla s grant portfolio encompasses oral health, mental health and safety net health care services. Gibson has led the Foundation s investments in HIT, tele-health and systems-level collaboration focused on expansion of primary care and mental health services across a nine-county, metropolitan region. Ms. Goldberg is a Principal Consultant with BluePrint Healthcare IT where she focuses on the design and implementation of regional, ambulatory, and hospital care coordination programs. Previously, Rebecca served as the Director of Operations for NJ-HITEC, New Jersey s Regional Extension Center. She was a member of the NJ State HIT Coordinators Health Action Team Committee, and participated in the state committee to review and implement an electronic health record system across NJ State Agencies.
Stakeholders and Participants Health Depts. Community Mental Health Centers Medical Society Other Community Partners FQHC s Safety Net Orgs. HIO s Hospitals Foundations
Missouri Health Connection LACIE KHIN TIGER Health Partnership Clinic Swope Health Services Turner House Children s Clinic Johnson County Health Depart Wyandot Inc. Mercy & Truth Medical Mission Riverview Health Services WyJo Care Unified Government Public Health Dept. Participant Clinic Mental Health Health Dept. Specialty Care Hospital Kansas University Medical Center Shawnee Mission Medical Center HL7 ADT,ALL,ABS,IMM PORTAL HL7 PORTAL HL7 XDS.b CCD XDS.b CCD PORTAL XDS.b Meds,labs,IMM, ADT XDS.b CCD XCA Query Truman Medical Center XCA Query ADT HL7 XCA Query XCA Query XCA Query XCA Query XCA Query North Kansas City Hospital Liberty Hospital ReDiscover Mental Health Truman Behavioral Health Comprehensi ve Mental Health Tri-County Mental Health Johnson County Mental Health Southeastern Kansas Mental Health XDS.b CCD XDS.b CCD XDS.b CCD Heartland Regional Drug and Alcohol Center XDS.b CCD XDS.b CCD Interface Status LIVE IN-PROCESS NOT STARTED
REACH perspective on Kansas City s healthcare delivery system Established in 2003 to improve health of uninsured and medically underserved people in six-county region Since 2006: REACH invested $43 million Safety net primary care - mental health - oral health services Maintained focus on increasing access & quality in systems perspective Recognized challenges: Fragmented safety net health care system Patient mobility and lack of robust health information Resulted in: Uncoordinated transitions of care among providers Poor health outcomes Increased costs to health care system
Genesis of the KC Metro Area Safety Net HIE Initiative THEN NOW REACH investment in an earlier HIE endeavor had failed Lack of community readiness HIOs were non-existent Passage of ACA accelerated safety net health care providers interest HIOs emerging Safety net primary care and mental health providers have implemented EMRs or are in process Benefits of connecting to an HIO are better understood by providers
Commitment to Collaboration with HIOs NOW Two state-based HIOs - planning partners on initiative Funding KS HIO to support marketing for patient portal; in discussions with MO HIO on funding needs REACH subsidizing participating clinics and community mental health centers connectivity fees to the HIOs Beginning year three of third-party services: Internal project management Oversee workflow redesign necessary to utilize the exchange and data Ensure functionality to efficiently share and use clinical data
REACH Foundation vision for region and expectations for the program The EHR and HIE provide many opportunities for administrative time savings, care coordination across providers and improvements in patient health care; Participating providers share patient information (demographic, medications, lab results and medical history); Full implementation of use cases focused on patients with chronic disease or those that are most at risk for poor health outcomes; Less fragmentation of health care across providers in the region; improve care management; reduced cost to health care system and improved health outcomes.
Opportunity for Collaboration and Technology Conduct 360 readiness assessment Perform needs and benefits analysis Identify preliminary use cases Validate findings & opportunities Utilize findings to define value statement Identify challenges & areas of risk
360 Readiness Assessment Culture Values Readiness to change Resources Technology Process Programs Services Population served Business partners Financing
From Assessment to Use Cases Behavioral Health Maternal Health Secure Messaging
Learning Objective 1: Organize regional collaborations using a program framework that unifies participants on shared goals, measurements and accountability Challenges Key Takeaways Time consuming Resource and process intensive Exposes participant challenges & systems deficiencies Readiness assessment and needs analysis generate use cases Validate with end users & leadership Set appropriate expectations Requires continuous and thorough communication Align uses cases with organizational values & strategic initiatives Build collaboration & gain buy-in Formulate strategy to communicate challenges
Designing and Implementing a Successful Use Case Map commonalities across participants Define and select a common patient population Identify the required data set and tools Team with clinical, administrative & practice staff for design of workflows
Map Commonalities Across Participants Access Points Services Patient Population Resources Technology Goals Values
Learning Objective 2: Design regional initiatives with simple, but impactful, use cases for improving outcomes using current healthcare technologies Challenges Key Takeaways Impact to clinical documentation Lengthy implementation timelines Access to key business partners Interoperability Readiness assessment identified clinic end-user pain points Ensure that use case addresses end-user needs Communicate: end-state goals use case benefits use case requirements project dependencies participant un-met needs Manage project timelines and manage risk
Engineering Successful Adoption Early adopters should be identified during process Fast track and develop lessons learned to help accelerate deployment Communication plan and community outreach Plan for future expansion and program optimization
Restate the Value of the Mission After each cycle of progress reinstate and reinforce the value. Photo credit: www.1079thefox.com
Have a Liaison as Cheerleader Be sure your collaboration has a liaison! Keeper (and sometimes defender) of the vision Collaborative and encouraging Kind, but tough honesty Outside entity or representative best Buffer and insulator Photo credit: www.1079thefox.com
Learning Objective 3: Create a strong communication program with executive level sponsorship. Challenges Key Takeaways Competitive collaboration Prioritizing work effort Financial incentive Standard data set Immature technology Roadshow communicate value! Role of Liaison - Facilitator Comprehensive Planning communications, deployment, contingency, budget Readiness assessment enables expansion and defines future work
Capacity Building and Infrastructure System Success Measures: access, utilization, content Increase # of patient records Expand access to exchange Standard data set Information technology requirements (refinement) Adoption of direct messaging
Learning Objective 4: Create outcome measures and metrics that align with the design, and intended objectives, of the program. Challenges Key Takeaways Barrier to adoption is patient info is not available in exchange HIO-to-HIO technology challenges Access to key referral partners Can t assume type of organization will be your star adopters Sustaining adoption must have continuation of original education and knowledge share in organization No baseline of data to compare against Defining use cases to ensure strong referral partners are paramount Create strategy to ensure hospitals are key referral partners
What keeps us up at night?
Key Challenges HIE technology was not designed to facilitate care coordination activities. Lack of reimbursement model to support care and provide resources. Interoperability between the health information exchanges. Foundation PTSD failure of previously funded HIE program.
Pearls for success!
Top Recommendations Safety nets and HIOs should leverage key hospital relationships to enable better integration into the community at large and for more robust regional data sets. Develop three-year budget projections for Safety Net HIE initiatives to provide the kind of necessary horizons for success. Perform readiness assessments and gain explicit and implicit buyin by the leadership of Safety Net organizations, regional associations and foundations. Critical to program success. Start working early on dealing with interoperability issues between impacted HIOs in region.
HIMSS STEPS Model TREATMENT/CLINICAL: Maximizing value for patients served by Safety Net organizations from the implementation of HIE to improve health outcomes. Optimizing transitions of care by enabling comprehensive and coordinated referral process, accurate and efficient patient handoffs and tightly coordinated transitions of care between collaborating partners. Measure and report better access to care via fewer missed appointments, closer coordination and more coordinated hand offs and improved administrative inefficiencies. ELECTRONIC INFORMATION/DATA: HIE utilization by Safety Net end users increased by 16% in second month. The number of secure, direct messages sent between end users increased by 500% in the first two periods measured. http://www.himss.org/valuesuite
Questions Carla Gibson Senior Program Officer REACH Healthcare Foundation carla@reachhealth.org Twitter:@REACHHealthcare Rebecca Goldberg Principal Consultant BluePrint Healthcare IT rebecca.goldberg@blueprinthit.com Twitter: @BluePrintHIT